Provider Demographics
NPI:1922021229
Name:SHAVER, JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SHAVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COPELAND DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1225
Mailing Address - Country:US
Mailing Address - Phone:508-339-4144
Mailing Address - Fax:508-261-9940
Practice Address - Street 1:200 COPELAND DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1225
Practice Address - Country:US
Practice Address - Phone:508-339-4144
Practice Address - Fax:508-261-9940
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA37294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
354OtherFALLON
037294OtherTUFTS
B10190201OtherCIGNA
000000028125OtherBMC HEALTHNET
0401171OtherUHC
203660OtherRIBCHIP
MAK10014OtherMABC
6263OtherHPHC
B10190201OtherCIGNA
037294OtherTUFTS